Lots of Americans are at serious risk. Can we be civil and helpful, or is that to much to ask?
The Checkup with Dr. Wen
Last month, I received a message from Leslie in Michigan. Her husband is immunocompromised because he has Stage 4 chronic kidney disease. His nephrologist told him that a bout of covid could push him into permanent kidney failure, which would necessitate a lifetime of dialysis unless he could receive an organ transplant.
Because of his severe renal impairment, he would not able to take Paxlovid to treat a covid infection. The Food and Drug Administration has also revoked its authorization for the one remaining monoclonal antibody to treat covid and warned last week that Evusheld, the preventive therapy for those who don’t mount an adequate immune response to vaccination, might be ineffective against some subvariants, including the currently dominant XBB.1.5 strain.
“Needless to say, we are extraordinarily careful,” Leslie told me in an email. Her husband doesn’t go into any indoor public places, except for medical appointments. Though she isn’t at increased risk herself, she takes precautions to avoid infecting him. When she goes anywhere indoors, she wears an N95 mask, keeps her distance and leaves as quickly as possible.
“I realize that most Americans have moved on and are tired of the pandemic — we are too — but I am totally stunned at how selfish and unkind people can be,” Leslie wrote.
She described a recent encounter in a crowded airport bathroom. A woman came in to charge her phone, and Leslie asked her if she could please use the outlet on the other side of the bathroom.
“Rather than social distance temporarily to help protect me, she lashed out, telling me to ‘stay home’ and ‘don’t travel’ if I’m at risk,” Leslie wrote. “To make matters worse, she told people coming into the bathroom, ‘Can you believe this woman over there asked me to move because she’s at risk?’”
Most people aren’t this callous. But Leslie’s point remains: For millions of Americans who are immunocompromised or who live with someone who is, it extremely difficult to live in a country where most people no longer see covid as a threat. The same is true for elderly Americans who are more vulnerable to severe outcomes and those who simply wish to avoid the potential consequences of infection, including long covid.
Public health policy is complicated because it requires balancing the needs of various groups. Nearly every policy will be perceived as too restrictive to some and too permissive to others. Asking everyone to forgo all indoor socialization is not reasonable, nor are perpetual mask requirements in all settings.
But the challenges that Leslie’s family and many millions of others face must be acknowledged. And there are ways to address them so people are not relegated to a life of fear and isolation.
For example, I agree with Leslie’s proposals, as she wrote to me:
“Masks should be required in medical or dental situations until and unless covid becomes much less of a threat to those who are at risk. Many at-risk people already skip necessary medical and dental appointments due to fear of contracting covid, and optional masking in these venues only makes matters worse.”
“There should be an option for masked train cars and subway cars, and possibly some masked airline flights. … Public spaces should be encouraged to upgrade ventilation.”
“It is of the utmost importance that there be more funding for research on new treatments and monoclonal antibodies to treat immune-compromised people. Vulnerable people are dying unnecessarily because there are no good treatments for them.”
“Finally, it is critical that there be a public service campaign to inform the public about at-risk fellow citizens. Most people are not aware that we are out there — most at-risk people do not look any different from other people. Many not-at-risk citizens would be willing to take some steps to help protect vulnerable people if they only knew what was at stake.”
I am grateful to Leslie for sharing her story and policy prescriptions. These are reasonable policies that can safeguard the vulnerable while being minimally intrusive to everyone else. I hope governments and private entities, including medical and dentist offices, grocery stores and the travel industry, consider them.
And others should keep in mind that even if they no longer think of covid as a daily concern, there are those who still do. These individuals deserve our compassion, empathy and understanding — and our commitment to innovative solutions that can help them, too.
The Checkup with Dr. Wen
Last month, I received a message from Leslie in Michigan. Her husband is immunocompromised because he has Stage 4 chronic kidney disease. His nephrologist told him that a bout of covid could push him into permanent kidney failure, which would necessitate a lifetime of dialysis unless he could receive an organ transplant.
Because of his severe renal impairment, he would not able to take Paxlovid to treat a covid infection. The Food and Drug Administration has also revoked its authorization for the one remaining monoclonal antibody to treat covid and warned last week that Evusheld, the preventive therapy for those who don’t mount an adequate immune response to vaccination, might be ineffective against some subvariants, including the currently dominant XBB.1.5 strain.
“Needless to say, we are extraordinarily careful,” Leslie told me in an email. Her husband doesn’t go into any indoor public places, except for medical appointments. Though she isn’t at increased risk herself, she takes precautions to avoid infecting him. When she goes anywhere indoors, she wears an N95 mask, keeps her distance and leaves as quickly as possible.
“I realize that most Americans have moved on and are tired of the pandemic — we are too — but I am totally stunned at how selfish and unkind people can be,” Leslie wrote.
She described a recent encounter in a crowded airport bathroom. A woman came in to charge her phone, and Leslie asked her if she could please use the outlet on the other side of the bathroom.
“Rather than social distance temporarily to help protect me, she lashed out, telling me to ‘stay home’ and ‘don’t travel’ if I’m at risk,” Leslie wrote. “To make matters worse, she told people coming into the bathroom, ‘Can you believe this woman over there asked me to move because she’s at risk?’”
Most people aren’t this callous. But Leslie’s point remains: For millions of Americans who are immunocompromised or who live with someone who is, it extremely difficult to live in a country where most people no longer see covid as a threat. The same is true for elderly Americans who are more vulnerable to severe outcomes and those who simply wish to avoid the potential consequences of infection, including long covid.
Public health policy is complicated because it requires balancing the needs of various groups. Nearly every policy will be perceived as too restrictive to some and too permissive to others. Asking everyone to forgo all indoor socialization is not reasonable, nor are perpetual mask requirements in all settings.
But the challenges that Leslie’s family and many millions of others face must be acknowledged. And there are ways to address them so people are not relegated to a life of fear and isolation.
For example, I agree with Leslie’s proposals, as she wrote to me:
“Masks should be required in medical or dental situations until and unless covid becomes much less of a threat to those who are at risk. Many at-risk people already skip necessary medical and dental appointments due to fear of contracting covid, and optional masking in these venues only makes matters worse.”
“There should be an option for masked train cars and subway cars, and possibly some masked airline flights. … Public spaces should be encouraged to upgrade ventilation.”
“It is of the utmost importance that there be more funding for research on new treatments and monoclonal antibodies to treat immune-compromised people. Vulnerable people are dying unnecessarily because there are no good treatments for them.”
“Finally, it is critical that there be a public service campaign to inform the public about at-risk fellow citizens. Most people are not aware that we are out there — most at-risk people do not look any different from other people. Many not-at-risk citizens would be willing to take some steps to help protect vulnerable people if they only knew what was at stake.”
I am grateful to Leslie for sharing her story and policy prescriptions. These are reasonable policies that can safeguard the vulnerable while being minimally intrusive to everyone else. I hope governments and private entities, including medical and dentist offices, grocery stores and the travel industry, consider them.
And others should keep in mind that even if they no longer think of covid as a daily concern, there are those who still do. These individuals deserve our compassion, empathy and understanding — and our commitment to innovative solutions that can help them, too.
The Checkup With Dr. Wen: We need to do more to assist the immunocompromised
Innovative policies can reduce the risk of covid-19 for immunocompromised people.
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